These techniques are not ‘bad’ intrinsically, but they modify the

These techniques are not ‘bad’ intrinsically, but they modify the population of lymph nodes examined. Most studies either specified that they did not use fat-clearing techniques, or they were based on data from large databases, which do not specify if these techniques were or were not used. Most hospitals do not routinely use these techniques. Therefore, the question of whether the prognosis is altered by the use of fat-clearing techniques to recover

12 lymph nodes remains unanswered. In addition, these techniques require exposure Inhibitors,research,lifescience,medical to hazardous chemicals and increased expense. Simunovic and Baxter proposed standardizing both the surgeon’s lymphadenectomy and pathologist’s lymph node examination before considering implementing lymph node counts as quality indicators (49-51). Additional considerations and discussion Review Inhibitors,research,lifescience,medical of the link between increased numbers of lymph nodes retrieved and increased survival

amongst patients with colorectal carcinoma (5-8,52) illustrates the distinction between causality and association. It has been proposed that this association was secondary to more accurate clinical and pathologic staging, a phenomenon known as stage migration (9,10). However, more recent work appears to contradict this hypothesis by showing that the increased number of lymph nodes retrieved has not Inhibitors,research,lifescience,medical led to an increase in node-positive disease (12,13,51). Another possible association, the type of practice setting (academic institution versus community

hospital) in which surgeries are performed, also has been disproved by some groups (51). We speculate that the association of increased MEK inhibitor cancer survival with increased number of lymph nodes retrieved likely results from the tumor biology of colorectal Inhibitors,research,lifescience,medical carcinoma in the context of changing disease incidence. The literature has shown an increasing incidence of right-sided colon cancers over the last decade, which may be due to changing practice patterns among surgeons and clinicians. In Inhibitors,research,lifescience,medical right-sided tumors, there are greater numbers of lymph nodes retrieved, and right-sided tumors tend to be associated microscopically with a dense peritumoral infiltrate of lymphocytes. It has also been shown that right-sided tumors are associated with a high-rate of microsatellite instability (MSI) and an improved overall prognosis as compared to tumors not associated with these MSI. Improved survival may be due to increasing detection and therapy for cancers with better prognoses that happen to yield resection specimens with more easily identified lymph nodes. In spite of a large body of literature, a number of questions remain. For one, studies that further investigate host-tumor interactions are needed. Though the literature has demonstrated an increase in the number of lymph nodes retrieved in right-sided colon cancers, and their association with MSI is well known, no research has been performed that easily explains this association.

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